A Comparative Clinical Analysis Of Two Surgical Methods For Chiari Malformation Type Ⅰ

Objective(s):The cerebellar tonsil malformation(Chiari Malformation,CM),also known as Chiari malformation or Amold-Chiari malformation,was first proposed and typed by the Austrian pathologist Chiari in 1891.Among them,Chiari malformation type Ⅰ is the most common in clinical practice,and the current operation for cerebellar tonsil mandibular malformation It is the only effective treatment,but currently there are various surgical methods in the clinic.Among them,the simple posterior fossa decompression and posterior fossa decompression and duraplasty are the most commonly used,but the postoperative clinical practice of these two surgical methods symptom improvement and complications were controversial,so we conducted a case-control study and meta-analysis of this controversy to evaluate simple posterior fossa decompression and posterior fossa decompression and duraplasty angioplasty in CM-1 The effect of postoperative clinical symptoms improvement and postoperative complications in patients.Methods:Part Ⅰ:Collection of detailed information on patients with cerebellar tonsillar malformation type Ⅰ complicated with syringomyelia who underwent concurrent surgical treatment from January 2009 to September 2018,the First Affiliated Hospital of Kunming Medical University,a total of 49 cases,and analyzed:1 The differences in basic data such as age and gender between PFD group and PFDD group were compared.2 The short-term and long-term clinical symptom improvement rate,imaging changes and complication rate of PFD group and PFDD group were compared.Part Ⅱ:Using computer search:Embase、Cochrane、ScienceDirect、Pubmed、Medline、Ovid、Wanfang,、Zhiwang and other databases since the establishment of the database until 2019,screening papers on PFDD and PFD for comparative analysis of randomized controlled studies or non-randomized controlled studies.The main outcome measures were the improvement of clinical symptoms and imaging,the complications and the rate of second operation.Results:Part Ⅰ:A total of 49 cases in our department met the inclusion criteria,including 17 males and 32 females,aged 12 to 57 years,mean 39.2 years old,with a course of 2 weeks to 6 years,an average of 2.8 years,followed up for 3 months to 5 years,with an average of 2.3.There were 21 patients in the PFD group and 28 patients in the PFDD group.The PFDD group was superior to the PFD group(P=0.045)in terms of clinical symptoms improvement in the near future(discharge day).The postoperative complications were higher in the PFDD group than in the PFD group(P=0.018);Due to the long follow-up of the case,some cases failed to complete follow-up,35 cases were completely followed up for 6 months by telephone follow-up,outpatient review,15 cases in PFD group,20 cases in PFDD group,and chi-square test P=0.028,that is,the improvement of long-term clinical symptoms in the PFDD group was better than that in the PFD group;there were 30 cases of MRI films,13 cases of PFD group,17 cases of PFDD group by 6 months after operation,and analyzed by chi-square test.The improvement of cerebellar tonsils in the last 6 months,P=0.03,suggested that the cerebellar tonsil retraction rate was higher in the PFDD group than in the PFD group;the syringomyelia was analyzed 6 months after surgery,P=0.027,suggesting that the PFDD group was postoperatively.The rate of syringomyelia improvement was higher than that of the PFD group.Part Ⅱ:A total of 1483 articles were searched in the databases,of which 10 were in accordance with the inclusion criteria(3188 in total,including 1383 cases of PFDD and 1805 cases of PFD),9 were retrospectively controlled studies and 1 was prospectively randomized controlled study.The improvement rate of syringomyelia in the PFDD group was higher than PFD group[OR=5.53,95%Cl(2.86,10.69),P<0.00001];the overall improvement rate of postoperative clinical symptoms in the PFDD group was higher than PFD group[OR=2.53,95%Cl(1.30,4.91),P=0.006];the total postoperative complications of the PFDD group were higher than PFD group[OR=3.46,95%Cl(1.40,8.59),P=0.007];There was no significant difference between the two operations in the PFDD group and PFD group[OR=0.37,95%Cl(0.10,1.31),P=0.12];the incidence of cerebrospinal fluid leakage after PFDD group was higher than PFD group[OR=4.79,95%Cl(1.80,12.73),P=0.002].The incidence of pseudodural enlargement in the PFDD group was higher than PFD group[OR=1.89,95%Cl(1.28,2.79),P=0.001];there was no statistical comparison of postoperative incision infection between the PFDD group and the PFD group[OR=1.44,95%Cl(0.57,3.59),P=0.441;there was no statistically significant difference in the incidence of postoperative occiput pain between the PFDD group and the PFD group[OR=1.49,95%Cl(0.46,4.89)),P=0.51];incidence of subcutaneous efftusion after PFDD and PFD The comparison was not statistically significant[OR=1.71,95%Cl(0.50,5.80),P=0.391.Conclusion(s):1.For patients with CM-1 with syringomyelia,the effect of posterior fossa decompression and duraplasty is better than posterior fossa decompression in the improvement of postoperative clinical symptoms.2.For patients with CM-I with syringomyelia,the effect of posterior fossa decompression and duraplasty is better than posterior fossa decompression in postoperative imaging improvement.3.For patients with CM-I with syringomyelia,the postoperative complication rate was higher in the posterior fossa decompression and duraplasty than in the posterior fossa decompression.4.Combined with the data of our case analysis and the data of meta-analysis,the posterior fossa decompression plus dural prosthesis is more suitable for patients with CM-I combined with syringomyelia,which can make patients get more benefits.